The Role of Foot Collateral Vessels on Ulcer Healing and Limb Salvage After Successful Endovascular and Surgical Distal Procedures According to an Angiosome Model

Abstract

Objectives: Analyze the influence of the collateral distal vessels on ischemic ulcer healing and limb salvage after successful distal procedures, according to an angiosome model. Methods: Retrospective analysis of 76 ischemic ulcers revascularized by surgical (n = 41) and endovascular (n = 35) distal procedures. All interventions were primary procedures with single outflow vessel that remained patent during follow-up. Ulcers were classified according to an angiography angiosome study as ‘‘direct revascularization’’ ([DR] n = 45), ‘‘indirect revascularization’’ ([IR] n = 31), and IR ‘‘through collaterals’’ ([IRc] n = 18). Healing rates and limb salvage were compared according to the type of revascularization. Results: Ulcer healing rate at 12 months was higher in DR than in IR (92% vs 73%, P = .008) but similar to IRc (92% vs 85%). Limb salvage at 24 months was higher in DR than in IR (93% vs 72%, P = .02) but similar to IRc (93% vs 88%). Conclusion: Ulcer blood flow restoration through collateral vessels may give similar results to those obtained through its specific source artery.

Keywords

critical limb ischemia healing limb salvage angiosomes

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